Archive for June, 2018

It’s that time of year when a new wave of student nurses surge to University, many fresh from A levels and wet behind the ears, more so as mummy didn’t teach them how to dry properly, before packing their lives into the back of the family car and dumping them into a rat infested student digs somewhere. Oh sweet joy!

Oh no….. Students carry disease….. Lets move out!

I’m not writing today to moan about the overly enthusiastic drunks and there unrealistic idealization of nursing, but to give them a few starters from a ye olde Nurse Practitioner….

It’s a post inspired by a young lady, who I love to pieces in a paternal kinda way- hasten to add – or the poor love will go to University having nightmares!! She came to the surgery as a child slave an apprentice in Reception. Soon the nursing team recognised her brilliance and kidnapped her. Before we knew it we had a fantastic health care assistant on our team. She smiles all day long, she is always professional and she appears to love what she does. (I know you cynical old nurses are thinks the NHS will soon beat that out of her! – but I think she’s tough enough!) Our loss as a surgery is a massive gain to the NHS and nursing at large.

Now all student nurses have to learn from there mistakes, and they all WILL make mistakes, but I felt I could give a heads up from my experiences as and with student nurses.

The sentence “Ahh, Mr Jones, I’ve got to put this wobbly tube up you willy!” Is scary enough for the patient, without him knowing you hands are shaking and you’re really not sure if it’s gonna slide in nicely or have to go over his enlarged prostate like a motorbility scooter with no suspension over a speed bump.

2. Don’t under estimate the brilliance of having Vicks on your wrist if the job is a stinker.

3. Do learn the difference between being assertive and aggressive.

4. Do develop your own “look” to give inappropriate comments from patients and Doctors.

5a. Never, ever sleep with a Doctor.

5b. More to the point never- ever stay awake all night with a Doctor – unless of course you are both on a night shift.

6a. Don’t try to sound clever, leave the bullshit baffles brains stuff to the 1st year medical students. Your job is to be human and make the patient understand and not feel stupid. Big words and diagnosis don’t make you look clever, they just make the patient feel thick.

6b. On that note – never assume a patient has any level of common sense. It’s your job to explain to a patient that eating beetroot doesn’t cause you to piss blood, it just turns your wee red.

6c. On that note, never assume your patient isn’t in fact a consultant specialist for exactly the condition they are in hospital with… Even consultants get ill! 😷🤒

6d. On that note…… Never assume a doctor has common sense. It’s your job to explain that the patient with the broken ankle and broken clavicle can’t go home on crutches.

9. Don’t turn up to work on an early shift after a night drinking Beer with an Irish girl/boy you’ve only just met, cos you quite liked her/him, and then spend the morning feeling green and probably smelling of alcohol (you can pretend it’s the smell of hand gel all you like, no one is convinced), and then running off to vomit when someone lifts the lid on the lunch trolley! (I’ve obviously never done this – I am just saying, it could happen!)

10. Don’t put all the patients dentures together in one bowl to clean them.

11. Do expect nurses to try to send you to the orthopaedic wards to get a long stand, or Pharmacy for Bowman’s Capsules or Gynae for Fallopian tubes, or even Endocrinology for diabetic soap.

I asked for a long stand 20 minutes ago…. How long does it take to get one?

12. Do stand at right angles to patient when squeezing anything or if any orifice is exposed.

13. Do prepare to feel like you’re living in a post apocalyptic campus from June to October, when all the business studies, drama students and media studies students are on there summer holidays – and don’t expect there will be anyone left to open the student bar!

14. Do not ever bitch about a member of staff: they are all related and that bitch of a ward manager, just happens to be married to the Consultant that’s sat at the desk next to you and her nephew is the orderly that just picked up your coffee cup……. (like you will have time for coffee! ☕).

15. Do not ever think you’ve seen it all. I still haven’t. The general public will forever stun and amaze you!

16. Don’t expect willies and vagina’s to look like any willy or vagina you’ve seen before!! It is not acceptable to say to a male patient complaining of penile pain: “Well I wouldn’t worry about a little thing like that!”

17. Do expect to find a whole new world of smells. If there was a sliding scale for odours it would start with sweaty belly button and escalate to Melena -(no, that isn’t the obese woman in Bed 4’s name!)

18. Do expect to hear some hugely inappropriate humour. It is how we survive.

19a. Don’t expect to find linen in the linen cupboard.

19b. Do expect to go in the linen cupboard and see even the most senior members of staff crying so severely they produce snot bubbles. It is also how we survive.

20. Don’t ever look like you’ve got nothing to do. If you have nothing to do, ask what you can do to help, you’ll get given a sensible job. If you stand around gormlessly without asking what you can do to help, you will be asked to clean all the bedpans or feed the amazing, porridge spitting, viper nicknamed Psycho-gran.

Lean closer dear…I didn’t quite hear you….

So there you go…. A few starters… Enjoy and remember from this day forth, you will experience a privileged look at life that very few of your “normal” friends will ever understand… Welcome to the club.

So I am busy, and I don’t write much, but when I finally get around to posting something, I get a comment from Nurse Fox, saying I should write more often. I offer the gobby fox and opportunity to try her hand in my absence, and rather than being a fox she turned out to be a game bird…she writes:

I admit I am a late comer to this blog, but at present I am on a work conference ( primary health care – it was free so couldn’t pass up the opportunity) and stuck in one of those delightful cheap ( I got study leave but am paying for travel and hotel myself) hotel rooms that isn’t quite clean enough to walk around in bare feet. (Max: Like one of those patient houses where you wipe your feet on the way out!). I have a motorway and petrol station for my view and can hardly hear the radio above the noise. So I need to amuse myself and this blog is certainly doing that. It is also delaying my trip to the petrol station for ‘dinner’, which I am thinking may consist of some kind of pasty, a bag of crisps and a chocolate bar. Do you think lawyers and politicians have this kind of experience on business trips ?

Upon asking Mr Nurse if he would mind getting off his lazy arse and produce more frequent musings he invited me to ‘have a go’. This is where my problem starts, I’m rubbish at writing and my spelling and grammar would turn a primary school teacher (Max: and your editor….) to drink. But one of the many flaws in my personality is that I love a challenge , no matter how dangerous, impractical or just plain daft if may be – so far this includes;

Flying to Tanzania alone and getting stranded in 3 different countries before getting to start work on a medical boat treating conditions I had never seen before;
Climbing Mount Kinabalu ( highest mountain in SE Asia) alone;
Attempting to Climb Mount Kilimanjaro this September alone;
Joining a choir when I can’t sing;
Asking a GP for a job and to train me where no position existed;
Undertaking my Masters whilst working 2 jobs and doing diabetes and CVD modules ( plus 2 kids , 2 dogs and husband);
Popping out 2 sprogs without any analgesia;
Challenging the process used by the RCN to ban staff from their forums and getting the process changed. Yes it was me that got banned!
Always having something to say at CCG meetings, however unpopular that makes me.

Now some people may assume this makes me rather annoying, and they would be right. But a lot of this comes from the fact that I am passionate about being a nurse and doing what is right for my patient as well as myself.

So yeah I will give it a go, I have come across many issues that Max has previously blogged about, although I am nowhere near as bright or funny, (Max: Stop blowing smoke up my arse!).

I thought I might chat about something I have grown intimate with although I don’t actually have one. (Max: it sounds like you’ve got balls so it isn’t that…)

Picture the scene “bend your legs up further Mr Smith , if it hurts or you want me to stop please just say, don’t kick “ gloves and lube at the ready, I’m going in….. ….(Max: “…and if you are really enjoying it please don’t say!”)

So how did Mr Smith end up with his knees by his chin, clenching his sphincters as if his life depended on it . Luckily , even though he has his pants down in front of a (moderately) attractive nurse practitioner , he has no risk of getting an ill timed , inappropriate erection… he is just too bloody petrified.

He ended up here the same way most of his contemporaries will, his wife told him to go and get “things looked at.”

He has been experiencing lower urinary tract symptoms (LUTS) which he has gainfully been ignoring, but the wife is sick to death of being woken up several times a night. She is worried it might be cancer, and even he cannot fail to have noticed the recent prostate awareness campaign that is popping up through his regular sports viewing.

Luckily for him he has symptoms , that makes it extremely unlikely he has prostate cancer , and if the symptoms were caused by cancer it would be very advanced and he would be unlucky enough to not likely make it past a few years.

But lets get back to the cheerful side of prostates, incontinence and cancer.
LUTS are caused by Benign Prostate Hypertrophy (BPH) or in rare cases very advanced metastasised prostate cancer.

The recent prostate campaign has seen an influx of the ‘worried well’ or as Max likes to describe them the ‘acutely well ‘ for PSA tests and , and if you can convince them, a digital rectal exam…..(Max: I love the idea of it being called a digital rectal exam…and patients thinking it’s a new fandangled technology..like digital radio, and then getting a very low tech finger up the arse!)

As healthcare professionals we tend to scoff at the ‘well’ asking to have blood taken and a finger inserted up their bum. We listen to the ‘my wife sent me’ story and wonder if these men are hen pecked, and why couldn’t they decide to come themselves , but that’s a whole other story.
Statistics show that most prostate cancers do not produce any symptoms. So we are being advised , by the experts , that if a man has plucked up the courage to come in and see you and asks to be poked and prodded ( even if his wife has him in an arm lock) we should oblige.

Family history and race are better indicators than symptoms .
If you are a man over 50 ( nearly there Max) then you have a 1:8 chance of getting prostate cancer, if you also happen to Afro Caribbean that increases to 1:4. Not great stats for Mr Marley from Trinidad ! More men die of prostate cancer than breast cancer, but breast cancer has 10 times more funding. it appears breast is a ‘sexier ‘cancer that people are willing to throw money at.

Numbers needed to screen (NNS) are just 293 for prostate , yet 2000 for breast and 1200 for bowel cancer and that’s with screening programmes .
PSA (Max: Prostate (not very) Specific Antigen) , although not perfect, is one of the best tumour markers around. Just remind your men, no ejaculation (yes they usually roll their eyes as if to say ‘chance would be a fine thing’), vigorous exercise or prostate massages (for prostatitis or pleasure !) for 48 hrs before the test. (Max: definitely no masturbating while riding a bike then!)

It’s a no brainer, if a young (experts advise 40 years onward) man comes in with not a single symptom we should screen him, even if it goes against our gut instinct.

You can also lighten the mood at the end of the consultation by letting him know that if his screening came back suspicious, he no longer has to have a foot long needle stuck into his rectum, winding its way through his poo and into his prostate whilst awake. They like to use MRI now, with biopsies taken through the perineum using a ‘Battleship’ type grid and approach – “needle 1 to square B6″… so no chances of sinking any battleships, just straight into the old prostate.

Finishing on a cheerful statistic, the new robotic machines that undertake a significant amount of prostate removals only malfunction in 1:1000 cases.